Background and AimHelicobacter pylori infection is a major cause of peptic ulcer disease and gastric cancer. Limited data exist on H. pylori prevalence and risk factors of infection among elderly individuals in Vietnam. This study aimed to determine the prevalence and associated risk factors of H. pylori infection in elderly Vietnamese patients with upper gastrointestinal symptoms.MethodsA cross‐sectional study was conducted on patients aged ≥ 60 years with upper gastrointestinal symptoms who underwent endoscopy. The exclusion criteria included recent antibiotic or proton pump inhibitor use, prior H. pylori eradication, or upper gastrointestinal surgery. Data on demographics, hygiene, diet, and history were collected through structured questionnaires. H. pylori was diagnosed by a rapid urease test. Logistic regression was used to analyze risk factors.ResultsOf 406 participants (mean age 65.4 ± 4.5 years, male‐to‐female ratio 1:2), H. pylori prevalence was 55.6%. The risk factors for H. pylori infection included infrequent tooth brushing (OR 18.14, 95% CI 3.94–83.55), overweight/obesity (OR 5.82, 95% CI 3.44–9.88), spicy food consumption (OR 5.18, 95% CI 2.74–9.79), a family history of upper gastrointestinal symptoms (OR 3.15, 95% CI 1.84–5.39), and cat ownership (OR 2.01, 95% CI 1.10–3.68). The vegetarian diet was protective (OR 0.04, 95% CI 0.01–0.18).ConclusionsH. pylori prevalence in elderly Vietnamese is high, with risk factors including poor hygiene, obesity, spicy food, family history, and cat ownership. A vegetarian diet may be protective.